[en] For ages, anxiety has been pointed out as the main etiological factor for sexual dysfunction. Since Wolpe, Masters & Johnson and Kaplan, the understanding of the influence of stress on sexual reactions has greatly evolved. This article retraces the milestones of such an evolution. In two decades, the reciprocal inhibitory theory has been replaced by a theory describing more accurately the complex relationship between anxiety and excitation. The combined development of plethysmography and cognitive psychology has greatly contributed to clarify this relationship. Indeed, the relationship between anxiety and sexual arousal appears more complex than originally recognized.
Plethysmography directly measures genital vasocongestion at presentation of erotic stimuli and thus permits an objective assessment of sexual arousal in varied circumstances (erotic, anxiety producing, neutral or distracting). In studies using this paradigm, anxiety appears to have a non linear influence on sexual arousal: sometimes it is inhibitory, other times it is facilitative.
Articulating the results obtained using plethysmography with the latest development in cognitive sciences, the following hypothesis came to mind: erotophobia could be considered of factor of vulnerability towards cognitive interference. In a sexual situation, erotophobic subjects focus primarily upon danger related information. This could engender a massive irruption of non erotic cues (non relevant task information) in working memory. Therefore, cognitive function available for sexual arousal would be diminished and sexual activity would be impaired. This hypothesis brings light onto the inhibitory effect of anxiety on sexual arousal among dysfunctional subjects. When this cognitive interference is not present, anxiety rather reinforces sexual arousal: either by increasing the focus of attention towards sexual cues or by misinterpreting the physiological reactions induced by the stressful situation as being sexual in origin.